Healthy Relationship Education for Dating Violence Prevention Among High-Risk Youth

Children and Youth Services Review 33 (2011) 173–179

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Children and Youth Services Review

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Healthy relationship education for dating violence prevention among high-risk youth

Becky F. Antle a,⁎, Dana J. Sullivan c, Althea Dryden b, Eli A. Karam a, Anita P. Barbee b a University of Louisville, Kent School of Social Work, Marriage and Family Therapy Program, United States b University of Louisville, Kent School of Social Work, United States c Western Kentucky University, United States article info abstract

Article history: A federal grant was awarded to provide the Love U2 healthy relationship curriculum to low-income, high-risk Received 1 April 2010 youth. This research sought to examine the relative effectiveness of a brief intervention with this curriculum Received in revised form 27 August 2010 compared to the much more intensive relationship education programs that have been previously provided to Accepted 31 August 2010 high-risk youth. Data were collected from 233 participants through measures of training and relationship Available online 8 September 2010 outcomes pre- and post-training. Participants experienced high levels of training satisfaction, significant increases in relationship knowledge and self-efficacy related to conflict resolution. They also experienced a Keywords: fi Relationship education signi cant improvement in attitudes toward couple violence in the desired direction. Implications of these High-risk youth findings for promoting healthy relationships and reducing dating violence among high-risk youth are discussed. Violence prevention © 2010 Published by Elsevier Ltd. Healthy Relationships

1. Introduction psychological aggression (i.e., control and jealousy) was significantly associated with physical aggression both concurrently and 3 months The prevention and reduction of youth dating violence has become later (O'Leary & Slep, 2003). Research suggests that experiencing an issue of national urgency. In recent years, hundreds of healthy dating violence in adolescence increases the likelihood of experienc- relationship programs have been funded by federal agencies to ing future relationship violence (Close, 2005; Wekerle & Wolfe, 1999; provide relationship education to various target populations. These Wolfe, 2006). programs seek to promote healthy relationship knowledge and skills Risk factors for dating violence include younger age (adoles- and to reduce interpersonal violence. In an assessment of possible cents), gender (females), and experience of other potentially configurations of these relationship education programs, Ooms and traumatic events or recent life stressors (Wolitzky-Taylor, 2008). Wilson (2004) state that “older adolescents and young adults in high Inter-parental violence directly predicts teen dating violence, schools and community colleges are another key audience for while the impact of nonviolent parental conflict on dating violence relationship education programs... (pg. 445).” The present study is mediated by adolescent appraisal of this conflict and their addresses issues of implementation and outcomes for one such emotional distress (Tschann, Pasch, Flores, & VanOss Marin, 2009). healthy relationship program for high-risk youth. Other studies have found that history of the physical abuse and sexual abuse of adolescents' parents increase the risk of dating 2. Prevalence and impact of dating violence violence for that adolescent (Leiderman & Almo, 2001; Manseau, Fenet, Halbert, Collin-Vezina, & Blais, 2008). Several studies have One in five teenage girls has been physically or sexually assaulted found that attitudes toward violence are important predictors of by a dating partner (Silverman, Raj, Mucci, & Hathaway, 2001) and dating violence. For example, Josephson and Proulx (2008) found has experienced emotional abuse (Halpern, Oslak, Young, Martin, & that there is a direct causal effect of violence-tolerant attitudes and Kupper, 2001). Others report that 54% of teens are aware of dating psychologically aggressive strategies on physical violence against violence among their peers (Jaffe, Suderman, Reitzel, & Killip, 1992). dating partners. Knowledge of healthy relationships contributed to African American youth are overrepresented as victims and perpe- a reduction in violence among boys' friendships, and had an trators of teen dating violence, with 14% reporting that they had been indirect effect on physical violence by reducing violence-tolerant abused, compared to 7% of their white youth counterparts (Centers for attitudes. Disease Control & Prevention (CDC), 2006). It also was found that The consequences of interpersonal violence are numerous, and include physical and emotional problems, as well as social and academic difficulties. Studies have found that 8% of males and 9% of ⁎ Corresponding author. Tel.: +502 852 2917, fax: +502 852 0422. females have been to an emergency room for an injury received from a E-mail address: [email protected] (B.F. Antle). dating partner (Foshee, 1996). Victims of dating violence are more

0190-7409/$ – see front matter © 2010 Published by Elsevier Ltd. doi:10.1016/j.childyouth.2010.08.031 174 B.F. Antle et al. / Children and Youth Services Review 33 (2011) 173–179 likely to engage in physical fights, sexual activity, binge drinking, drug patterns in the treatment group but no such increase in the control use, and suicide attempts (Ackard, 2007). The rate of substance abuse group. She also documented a significant reduction in verbal is twice as high for females who experience dating violence than those aggression measured by the Conflict Tactics Scale for the who do not experience such violence (Plichta, 1996). Dating violence treatment group, while the use of verbal aggression increased is also related to high-risk sexual behaviors, which often leads to over time for the comparison group. unintended pregnancy, sexually-transmitted diseases, and HIV infec- Hammond and Yung (1991) also evaluated a healthy relationship tion (Silverman et al., 2001). Those who experience dating violence program for 15 at-risk middle school-age African American youth, the may suffer from problems with self-esteem and body image (Ackard & Positive Adolescents Choices Training (PACT). This program sought to Neumark-Sztainer, 2002), and often repeat these patterns of violence reduce violence across all types of relationships, not just dating in their future relationships (Smith, White, & Holland, 2003). Because violence, through 37 sessions on communication, problem-solving, youth who are victims of interpersonal violence often go untreated, and negotiation. These researchers assessed behavioral change they may carry over the sequelae of this abuse into their roles as through videotaped demonstrations of healthy relationship skills. In parents. Victims of interpersonal violence and abuse may find it a comparison of these 15 youth to 13 students who did not receive difficult to provide optimal parenting to their children (Leiderman & the program, they found that participants improved in all skills areas, Almo, 2001). They are more likely to live in poverty and experience particularly areas of significant deficit, and they experienced depression, which inhibits their ability to provide consistent and significantly less involvement in violence-related behavior and responsive parenting. suspensions/expulsions from school than those who did not participate in the program. 3. Current programs to prevent dating violence Wolfe et al. (2003) also evaluated a community-based intervention to promote healthy dating relationships among high-risk youth Most dating violence prevention programs are offered through with a history of child maltreatment through a treatment-comparison the school systems and are typically universal, targeting all male group design. The program included 18 modules on positive and female students in the school setting (Whitaker, 2007). alternatives to relationship aggression, healthy communication and Perhaps the most widely evaluated program, the Safe Dates conflict resolution skills, and gender-based role expectations. The project (Foshee, Bauman, et al., 1998; Foshee, Fothergill, & Stuart, program was effective in reducing incidents of physical and emotional 1998; Foshee et al., 1996), compared students who received 10- abuse and symptoms of emotional distress over time. session curriculum in schools tothosewhoreceivedcommunity services only. In a sample of 1886 eighth and ninth grade 4. Gap in the literature students who participated in the study, one month after the program, the treatment group had 25% less psychological abuse, Hence, the literature has begun to establish that relationship 60% less sexual perpetration, 60% less physical violence than the education programs can promote relationship knowledge (Adler- comparison group. There were also differences in attitudes in Baeder), skills (Hammond & Yung, 1991), and a reduction in desired directions between the treatment and comparison groups. violent behaviors (Wolfe et al., 2003) for high-risk or diverse One year following data, there continued to be differences in youth. However, these programs were all very time intensive and attitudes but no differences in behaviors (Foshee, Bauman, & most were delivered in a traditional school setting. The Love U2 Greene, 2000). At four years post-treatment, Foshee et al. (2004) Relationship Smarts curriculum consisted of 12 sixty to ninety found adolescents in the treatment group reported significantly minute modules administered in high schools (Adler-Baeder et al., less physical violence, serious physical violence, and sexual dating 2007); the Positive Adolescents Choices Training (PACT) program violence perpetration and victimization than the comparison (Hammond and Yung (1991) involved 37 sessions delivered in a group. middle school; and the Youth Relationships Project (Wolfe et al., While the Safe Dates program demonstrated an impact on 2003)offered18sessionstohigh-riskyouthinacommunity actual physical and sexual aggression, other programs have setting. This study seeks to address the issue of dosage—whether a produced positive short-term outcomes in the areas of knowledge program that is administered in a brief format can produce similar and attitude change. MacGowan (1997) evaluated a five-session gains in knowledge and skills for high-risk youth. In 1995, LaVoie dating violence prevention program for predominantly African et al. compared the effectiveness of short and long prevention American middle school youth and found an increase in knowledge programs for traditional school students to address attitudes and of healthy relationships and attitudes toward non-violence, but knowledge related to dating violence. They found that both found no changes in attitudes about physical violence or methods versions of the program were equally effective to produce positive of dealing with violence in relationships. Similarly, Avery-Leaf, attitudes, but the short version produced greater knowledge gains. Cascardi, O'Leary, and Cano (1997) identified that a five-session This research will address the effectiveness of a prevention school based program was an effective tool to change attitudinal program delivered in fewer hours (12) and in a compressed time correlates of dating violence among 102 high school students when frame (two days) for a high-risk population of youth. The compared to a no-treatment control group. In this study, there was previously mentioned programs for high-risk youth offered 12 to asignificant reduction in teen tolerance of violence as a means to 37 modules through as many sessions; the current study evaluated resolve conflict. a program that provided eight modules over two consecutive days. Therehavebeenfewerstudiesthathavefocusedondiverseor The question of dosage is particularly relevant given current high-risk populations of students. One study that included an budget constraints on educational and social service systems, as excellent representation of diverse students was conducted by well as logistical constraints relevant to high-risk youth such as Adler-Baeder et al. (2007). Adler-Baeder et al. (2007) evaluated difficulty with retention of participants in multiple sessions due to the effectiveness of the Love U2 Relationship Smarts curriculum, a their inherent risk factors. This issue of dosage is particularly 12 module (12–18 hour) program that focuses on healthy/ relevant for high-risk youth who have dropped out of the unhealthy relationship patterns and communication/conflict res- traditional school system, such as those served by the current olution skills, for high school students in the state of Alabama. She project. Barriers to retention of these youth include transportation, used a treatment (training intervention) and comparison group employment issues, neighborhood and family violence, teen design. She found a significant increase in knowledge about parenting, and stigma associated with social services and/or relationships and awareness of healthy/unhealthy relationship academic institutions. B.F. Antle et al. / Children and Youth Services Review 33 (2011) 173–179 175

5. Louisville Healthy Relationships Program integrated the Love U2 class into the regular course offerings at the Y. O.U. program. 5.1. Target population 5.3. Evaluation of Love U2 The Louisville Healthy Relationships Program has implemented the Love U2 Communication Smarts curriculum with high-risk youth There were two primary research questions guiding this evaluation: involved with a specialized program of the public school system, the Youth Opportunities Unlimited (Y.O.U) Program. “Youth at risk” can 1) What is the impact of a brief (two-day) healthy relationship be defined as young people whose background places them “at risk” of program on relationship knowledge and attitudes toward violence future offending or victimization due to environmental, social and among high-risk youth? family conditions that hinder their personal development and 2) What is the impact of a brief healthy relationship program on fl successful integration into the economy and society. Nearly 100% of communication and con ict resolution skills among high-risk the Y.O.U. participants meet this definition of at-risk youth. Seventy- youth? nine percent of those accessing intensive services are dropouts, 87% compute below a 9th grade level and 73% are reading below a 9th 6. Methodology grade level as measured by the Test of Adult Basic Education. The majority of participants come from ten zip codes that 6.1. Design represent the most economically and socially disadvantaged areas of Metro Louisville. Three of those ten zip codes have the highest This research utilized a pre–post-test research design. Data on number of Y.O.U. participants—the areas have been defined by Annie demographics, trainee knowledge of key concepts and skills are E. Casey Making Connections as areas facing higher than average risks measured pre-training. Trainee reactions to training, knowledge, for children and youth. In these areas, 112 incidents of child abuse per attitudes, and transfer of skills are measured post-training. 1000 children were reported compared with 71 for the county in 2000–01. Approximately 25% of all children in these three zip code 6.2. Sample areas live in poverty. There were 102 reported crimes per 1000 persons compared to 61 for the county. Teen violent deaths per There were 260 individuals who completed the Love U2 classes. As 100,000 persons were 105 (20% of the deaths in the county). Only 37% indicated above, classes were offered in two-day sessions. The of families with children were headed by married couples. Fifty-four retention rate of participants for all classes across all sites and formats percent of families with children were headed by single mothers and 9% was 93%. All 260 youth who participated in an initial Love U2 session were headed by single fathers. Over 72% of new mothers were were invited to participate in the study. For the current study, the unmarried, and 30.5% of new mothers were under the age of 20. The sample size was 233 subjects for the pre-training surveys and 202 teen birth rate per 1000 females ages 15–17 was 83.5. The median age subjects for the immediate post-training surveys. The 233 subjects of birth mothers was 22.5 years. The highest area of need in these three represented a 90% response rate to the surveys at the pre-training zip codes is the empowerment zone. In the empowerment zone, 32% of data collection point. The response rate for immediate post-training birth mothers were under the age of 20, and 82% of the mothers were was 78%. There were no significant differences in demographic single. In addition 1268 physical abuse reports were made in the variables between these response groups, indicating that the results empowerment zone areas. The neighborhoods represented in the other for the follow-up periods are representative of the entire study seven zip codes of highest number of enrollees in the Y.O.U. program population. are also areas of high poverty, high crime, high teen pregnancy rates, There were 140 females (60.1%) and 93 males (39.9%). There were and low marriage rates. These demographics reflect numerous risk 167 African American participants (73.6%), 44 white participants factors for negative relationship outcomes for program participants. (19.4%), and 16 participants of other racial groups (7%). There were 125 participants (61.9%) who were unemployed, with the remaining 38.1% employed full- or part-time. For 88% of participants, the gross 5.2. Service delivery annual family income was $30,000 or less. These demographics are consistent with the general client population at the Youth Opportu- The Love U2: Communication Smarts (Pearson, 2004) curriculum nities Unlimited Program. consists of seven modules that address healthy and unhealthy relationship patterns, communication and conflict resolution skills, 6.3. Variables and measurement and general problem solving. This training teaches youth skills to form and maintain healthy relationships, as well as to avoid or end unhealthy Trainee demographics measured included gender, age, race, relationships. An eighth module was developed by this research team religion, marital status, education, occupation, employment status, to address issues of dating violence more directly. This curriculum is income, and number of children. Training satisfaction was measured particularly relevant for the high-risk youth identified for the described using a 15-item survey that evaluates the extent to which trainees project given the numerous risk factors described above. found the training enjoyable and useful. Participants rate the quality The eight modules of the Love U2 Communication Smarts of the training on a 1 to 5 Likert scale for each of these items. This curriculum are offered over two consecutive days on-site at the Y.O. training satisfaction scale has been used extensively in child welfare U. program for high-risk youth. Staff members from the Y.O.U. training evaluation and has strong reliability and validity with an program have been trained by project personnel to facilitate the alpha of .75 (see Antle, Barbee, & van Zyl, 2008). curriculum. Youth sign up for the Love U2 class with their career Learning was measured using a knowledge test of the training planners two weeks prior to the training. The classes averaged 10 curriculum written by the authors. This knowledge-based test was participants. Four hours of curriculum were presented per day with developed specifically for this research and consists of 20 multiple- the additional 2 h each day used for pre and post evaluation, breaks choice questions on material from each of the key content areas of the and lunch. Each student received a participant manual the first day of training. Trainees completed this test pre-training and immediately class and a certificate of completion the last day. Students also post-training. received a training incentive in the form of a $50 Visa gift card. Due to Transfer of skill was measured for two key skills from the training: the success of the class the administrators of the Y.O.U. program communication and conflict resolution skills. Participants completed 176 B.F. Antle et al. / Children and Youth Services Review 33 (2011) 173–179 the Communication Patterns Questionnaire (Noller & White, 1990) 7.2. Relationship skills and the Conflict Resolution Styles Inventory-Partner (Kurdek, 1994). Participants completed these surveys pre- and immediately post- In the area of communication (as measured by the Communication training. In a study of 96 married couples, Noller and White (1990) Patterns Questionnaire), there was a significant decrease in the reported the following Chronbach's alpha levels for the factors of the demand–withdraw pattern of communication, t (155)=3.59, Communication Patterns Questionnaire: Coercion: 0.86, Mutuality: pb.0001. The average pre-training score was 25.67 (SD=10.34), 0.88, Post-Conflict Distress: 0.73, and Destructive Process: 0.79. They and the average post-training score was 22.68 (SD=10.51).There was also found support for the discriminant validity of this scale. For the also a significant decrease in the mutual avoidance pattern of Conflict Resolution Styles Inventory (CRSI), Kurdek (1994) presented communication, t (158)=2.85, pb.01. The average pre-training preliminary psychometric data from a sample of lesbian, gay, and score was 8.36 (SD=3.95), and the average post-training score was married heterosexual non-parent, as well as married heterosexual 7.43 (SD=3.98). parent couples. For the CRSI-Self, the Cronbach's alpha ranged from In the area of conflict resolution (as measured by the Conflict .65 to .89. For the CRSI-Partner, the Cronbach's alpha ranged from .80 Resolution Inventory), there was also a significant decrease in the to .91. Scores were internally consistent and stable over a one year withdraw dynamic for conflict resolution, t (167)=2.04, pb.05. The period. For the CRSI-Self Cronbach's alpha ranged from .46 to .83, and average pre-training score was 10.00 (SD=3.89), and the average for the CRSI-Partner Cronbach's alpha ranged from .54 to .83. Kurdek post-training score was 9.46 (SD= 3.71). This decrease in the (1994) reports good face validity, evidence for convergent validity, withdraw dynamic represents an improvement in conflict resolution and evidence for concurrent and predictive criterion-related validity. skills. There was also a decrease in conflict engagement, t (167)= Attitudes toward relationship violence were measured using the 4.35, pb.0001. The mean pre-training score was 9.64 (SD=4.12), and Acceptance of Couple Violence scale (Foshee, Fothergill, et al., 1998). the mean post-training score was 8.48 (SD=3.51). The scale contains eleven items that measure acceptance of male or female violence, female on male violence, and acceptance of general 7.3. Attitudes dating violence. The reported internal consistency reliability is greater than .70 for all components of the scale (Foshee et al., unpublished). There was a significant improvement in attitudes toward couple violence (as measured by the Attitudes toward Couple Violence scale), 6.4. Procedure t (114)=2.04, pb.05. The mean pre-training score was 17.16 (SD=6.90), and the mean post-training score was 16.09 Approval was obtained from the Institutional Review Board of the (SD=6.99). A decrease in score represents an improvement in authors' university. A full consent form was used prior to the attitudes in the desired direction, participants are less likely to administration of the pre-test, through which subjects were informed indicate support for dating violence in romantic relationships. of their right to refuse to complete these surveys, not answer a specific question or questions on the surveys, or discontinue participation at 8. Discussion any time without penalty. The pre-test was administered on the first day of training prior to the initiation of the lecture. There is a referral 8.1. Key findings mechanism in place for any participant who becomes distressed during these research procedures. Facilitators of the training and the This study documented that a brief relationship education researchers collecting data have been provided with a written program can produce significant gains in relationship knowledge, protocol that includes a list of referral sources. If any subject becomes skills, and positive attitudes toward couple violence. Participants in distressed during these research procedures (or the training program the two-day Love U2 curriculum experienced a significant increase in itself), facilitators and/or researchers make appropriate referrals for relationship knowledge, with African American students (who services. The post-test was administered on the last day of training comprised approximately 74% of the sample) demonstrating the prior to dismissal. Recruitment strategies and materials were for greatest gains. This finding is consistent with previous research on participation in the training versus participation in the research. There youth relationship programs that found improvements in relationship was no targeted recruitment solely for the research. knowledge (Adler-Baeder, Kerpelman, Schramm, Higginbotham, & There is also a fidelity process in place, by which trained observers Paulk, 2007; MacGowan, 1997). document the degree to which trainers cover core concepts and utilize There was also a statistically significant improvement in commu- various training methods from the Love U2 curriculum. The fidelity nication and conflict resolution skills reported by program partici- assessment consistently showed very high levels of curriculum pants. Youth experienced a significant decrease in the demand– compliance and use of appropriate training methods. A full descrip- withdraw and mutual avoidance patterns of communication. This tion of the fidelity measure and outcomes of fidelity are reported finding reflects that youth think they are better able to manage elsewhere (Antle et al., unpublished). communication episodes so that they and/or their partners remain engaged. Similarly, participants reported a significant decrease in 7. Results withdrawal during times of conflict and an overall decrease in conflict engagement. The latter refers to a decrease in general frequency or 7.1. Satisfaction and learning pursuit of conflict in dating relationships. There were no differences by race, gender or other demographics in these changes. Other The average satisfaction item rating for the Love U2 training was research has documented a positive impact of relationship education 4.01 on a 5-point scale. The average total satisfaction rating for the 15 for communication/conflict resolution skills of high-risk youth items on the satisfaction scale was 60.14 (SD=13.14) out of a total (Hammond & Yung, 1991), but these findings were specificto possible score of 75. There was a significant increase in participant middle-school-age youth involved in a program of very long duration knowledge from pre- to post-training, t (202)=−11.76, pb.0001. (37 sessions). The average pre-test score was 30.76% correct (SD=13.18), and the Lastly, this study found a significant improvement in attitudes average post-test score was 42.61% (SD= 14.10). There was a toward couple violence. Youth reported a much lower acceptance of significant difference in learning based upon race, F (5,194)=2.83, violence in dating relationships. Other studies have examined the p b.05. Specifically, African American students learned more impact of relationship education on attitudes toward violence. Adler- (M=13.38% gain) than Caucasian students (M=5.69% gain). Baeder et al. (2007) found a similar result when Love U2 was provided B.F. Antle et al. / Children and Youth Services Review 33 (2011) 173–179 177 to diverse high-school-age students in a traditional school setting. maintenance of these gains over time is a key issue for consideration. Foshee et al. (2000) and Avery-Leaf also reported that relationship There is also a need to link these immediate outcomes to more long- education programs were effective in promoting appropriate atti- term outcomes such as reductions in relationship violence and tudes toward relationship violence. Like gains in communication and improvements in relationship quality and decision-making. Lastly, conflict resolution skills, there were no differences by race, gender or the measure of skills is through self-report. Participants may have other demographics in these changes. These attitudes toward violence inflated their level of appropriate communication and conflict have been found to serve as an important mediator of actual violence resolution skills. However, their belief that they will be less avoidant in romantic relationships. For example, Josephson and Proulx (2008) and violent in dating relationships is a measure of behavioral found that there is a direct causal effect of violence-tolerant intention. Other research shows a strong relationship between attitudes and psychologically aggressive strategies on physical behavioral intention and actual behavior (Josephson & Proulx, 2008). violence against dating partners. Knowledge of healthy relationships contributed to a reduction in violence among boys' friendships, and 8.3. Future research had an indirect effect on physical violence by reducing violence- tolerant attitudes. Much of the research and practice in this area is Future research should address these limitations by conducting a based upon the theory of planned action, which postulates and has longitudinal, randomized control trial of high-risk youth using the found evidence for the impact of attitudes and beliefs on intentions Love U2 healthy relationship curriculum. In such a study, there should and behaviors (Armitage & Conner, 2001). Thus, interventions that be direct measurement of communication and conflict resolution offer participants new information that undermines maladaptive skills through observational research methods, such as those used by beliefs and attitudes about relationships should lead to a change in Hammond and Yung (1991). Most importantly, this research should those attitudes and beliefs. examine the relationship between these immediate relationship gains Hence, this study began to address a key gap in the literature—the reported in this study (knowledge, skills, attitudes), and long-term issue of effective dosage of relationship education to produce positive relationship quality and safety. Other research in the dating violence outcomes for high-risk youth. While several previous studies literature has documented a positive impact of relationship education documented an impact of relationship education on diverse youth on physical and emotional violence (e.g. Foshee et al., 2004; Wolfe et (Adler-Baeder et al., 2007), high-risk middle school youth (Hammond al., 2003). However, these studies were evaluating the impact of such & Yung, 1991), and youth victims of family violence (Wolfe et al., education for traditional students and/or programs of much higher 2003), each of these programs was much longer in duration. Given intensity/duration. These issues should be examined in light of the significant community resource constraints and the potential diffi- dosage question addressed by the present study to determine culties associated with retaining high-risk youth in these types of whether a brief educational intervention can produce similar relationship education programs over time, this question of relative improvements in relationship safety for high-risk youth. Hence, effectiveness of a brief relationship program is critical. future research should collect relationship violence data and follow these high-risk youth over time. 8.2. Strengths and limitations 8.4. Implications for policy and practice There were several strengths of the present study. One strength of this study is the examination of multiple training outcomes for 8.4.1. Reduce barriers to service delivery the Love U2 relationship education program, including satisfaction, School systems and other potential community treatment provi- knowledge, skill, and attitudes toward violence. This training ders must deal with constraints around budgets, resources and evaluation model provides comprehensive data on the various retention rates when deciding on which programs to implement. This domains of impact for the Love U2 curriculum. Furthermore, research demonstrates that training that is brief and cost-effective, yet process outcomes such as the fidelity of the intervention were focused can have a positive impact on teen knowledge, skill evaluated to ensure that the intervention is consistent across development and attitudes around dating violence and healthy groups and sites. The results from this study are based on the use of relationships. Because the program is brought directly into a non- standardized scales with strong psychometric properties. There traditional academic service delivery setting and facilitated by wasalsoalargesamplesizeof233 high-risk youth. This study familiar staff, barriers to retention for high-risk youth such as highlights the difference between efficacy research, which is transportation, school instability, and conflict with staff, are greatly synonymous with highly controlled randomized clinical trials minimized. By tapping into an existing infrastructure, relationship research, and effectiveness research, which is more associated educators can form community partnerships and provide services that with transportable mental health services research. This research are convenient and accessible to potential participants. Based on these provides preliminary evidence that relationship skills/dating results, it may be possible to connect with a difficult teen audience by violence prevention curriculums can work in naturalistic, applied being brief in presentation and talking about relevant subject matter. settings. Unlike highly controlled, laboratory-based efficacy studies If teens find the information interesting, they will not only comply, that focus on participants with a specific issue, this effectiveness but learn from the overall experience. The content must be easily study took place in an unfiltered setting designed to provide accessible and written in way that academically low-functioning services for teens with multiple problems and risk factors. teens can comprehend. The brief format (dosage) of the program may However, there were also several limitations of this study. First, overcome barriers such as transportation needed for multiple there was no control group utilized, resulting in several threats to sessions, conflicts with work schedules for non-traditional students, validity (e.g. history, maturation). Nevertheless, given the limited life stressors such as neighborhood and family violence that might published research on the Love U2 curriculum (Adler-Baeder et al., cause absences, and the demands of teen parenting that are common 2007 is only identifiable study) and need for data on the training to many of these students. process and outcomes closer to the training intervention event that are critical in the training evaluation chain of evidence (Barbee & 8.4.2. Combine knowledge and skills Antle, 2009) such as satisfaction, learning, and skill acquisition, this Like other traditional dating violence programs, this curriculum study still makes an important contribution to the field. A second explains different types of abuse, cycles of violence and common limitation is the need for follow-up data. While participants reported victim responses. While insight into these areas is important, immediate gains in knowledge, skills, and positive attitudes, the knowledge and self-awareness alone may not be enough to help 178 B.F. Antle et al. / Children and Youth Services Review 33 (2011) 173–179 these high-risk youth. It is also crucial to learn a series of skills or tools References to deal in order to deescalate conflict and remain safe. Although designed originally for use in romantic relationships, these commu- Ackard, D. M. (2007). Long-term impact of adolescent dating violence on the behavioral fi and psychological health of male and female youth. Journal of Pediatrics, 151(5), nication skills can be used in all signi cant interpersonal relationships 476−481. (i.e. with parents, siblings, friends). These results stress the impor- Ackard, D. M., & Neumark-Sztainer, D. (2002). Dating violence and date rape among tance of combining both knowledge and skill acquisition in the adolescents: Associations with disordered eating behaviors and psychological health. Child Abuse and Neglect, 26, 455−473. education of couple violence. Adler-Baeder, F., Kerpelman, J. L., Schramm, D. G., Higginbotham, B., & Paulk, A. (2007). The impact of relationship education on adolescents of diverse backgrounds. Family Relations, 56, 291−303. 8.4.3. Focus on strength and health in a safe group setting Antle, B. A., Barbee, A. P., & van Zyl, M. (2008). A comprehensive model for child welfare − The Love U2 curriculum focuses on healthy relationships which training evaluation. Children and Youth Services Review, 30(9), 1063 1080. Antle, B. F., Karam, E. A., Sullivan, D. J., & Christensen, D. N. (unpublished). 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